Sajjad H Mirza.
Minimising antibiotic resistance - is there a way forward?.
Infect Dis J Jan ;16(3):75-9.

The over-riding principle of medicine is “Do no harm”, yet, in the case of antibiotics, harm is inevitable, for use (even appropriate usage) selects for resistance, complicating the treatment of future patients. Although reducing antibiotic prescribing seems the logical way to reduce selection pressure, the evidence that resistance can be reduced with reductions in antibiotic prescribing is mixed at best. Moreover, withholding treatment may be associated with serious consequences. The best we can probably hope for is that the harm of resistance can be mitigated by using antibiotics sparingly, with diverse (rather than cycled) use, and with a bias, at least in hospitals, to those agents (eg, beta-lactamase inhibitor combinations and carbapenems rather than quinolones and cephalosporins) that seemingly cause the least disturbance to the microflora. These aspects should be considered by the authors of antibiotic guidelines, who must also recognise that tunneling treatment down overtly narrow pathways may concentrate selection pressures. Lastly, the inescapable conclusion is that, to maintain our ability to fight infection, new antibiotic development must be re-started. And, here, the biggest potential harm is if we— as a society, regulators, and consumers—create a climate in which investment in the field is unattractive. This is a review article.

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